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General NPI Number Information
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NPI Number | 1679094148
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Entity Type | Organization
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Legal Business Name | ELEGANCE IN DENTISTRY
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 1 WINDING DR
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City | PHILADELPHIA
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State | PA
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Zip | 19131-2907
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Country | US
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Telephone | 215-883-0611
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Fax | 267-713-7371
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Provider Business Mailing Address
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Address Line | 1 BELMONT AVE STE 414
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1607
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Country | US
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Telephone | 610-617-0700
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Fax | 610-617-3443
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. KELLYN HODGES
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Credential | DMD
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Telephone | 610-617-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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